Client Forms | Investor Choice IRAs

Client Forms

Polycomp maintains a library of forms to help you complete transactions within your Investor Choice IRA® easily and efficiently.

If the form you are looking for is not available, or you have questions about a form, please contact us or give us a call so we can assist you.

Please email or fax completed form(s) to:

IRASupport@polycomp.net
(916) 773-3484 fax

Account Funding Forms

Incoming Transfer Form
Use this form to request a direct transfer of funds or in-kind assets from another custodian to your account at Polycomp Administrative Services.

Please note: Please remember to include a copy of a recent statement (dated within the last 60 days).
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Direct Rollover Request
Use this form to request a direct rollover of funds or in-kind assets from a plan administrator of a Qualified Retirement Plan to an eligible account at Polycomp Administrative Services.
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Deposit Slips
Complete this form when a deposit is made to your account for the following reasons: loan payments, return of funds, proceeds from a sale or maturity of an asset, income from rental properties, or interest and earnings.

This form may also be provided by a third-party when sending funds to Provident Trust Group on behalf of your Polycomp Administrative Services retirement account.

Please note: A deposit may be delayed if this form is not submitted. For additional deposit instructions & information, please download our Payment Information Sheet.
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Deposit Submission Form
This form is used when funds are deposited into a Polycomp Administrative Services account for a contribution or asset payment.

Please note: A deposit may be delayed if this form is not submitted. For additional deposit instructions & information, please download our Payment Information Sheet.
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ACH Deposit & Contribution Form
This form is used to request an ACH Deposit, one-time or on a recurring basis, into an existing Polycomp Administrative Services account.

Please note: Provident Trust Group, LLC as custodian initiates this transaction from your checking account and requires a copy of a voided check. For additional deposit instructions & information, please download our Payment Information Sheet.
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Rollover Contribution Form
This form is used to certify funds being rolled over into an existing Polycomp Administrative Services account.
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Roth IRA Conversion Form
This form is used to convert assets held in a Traditional IRA into an existing Roth IRA at Polycomp Administrative Services.

Please note: If you would like to establish a new Roth IRA, please click here.
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Roth IRA Conversion Certification
This form is used to certify that all or a portion of a Traditional IRA is eligible to move into an existing Roth IRA at Polycomp Administrative Services.
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Re-characterization Request
This form is used to re-characterize all or a portion of a previously completed Roth Conversion or IRA contribution to an existing Traditional IRA held at Polycomp Administrative Services.
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Asset Purchase/Investment Forms

Authorization to Take Action Form
This form is used to authorize Polycomp Administrative Services to take further action on an existing account or existing asset (i.e., 990T, sale of asset, extend loan terms, execute documents, obtain EIN).
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Direction of Investment - General
Complete this form to direct Polycomp Administrative Services to make an investment from an existing account.

Please note: This form is not used to direct Polycomp Administrative Services to pay an expense on an existing asset in your account. Please use the Expense Payment Authorization Form.
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Direction of Investment - Precious Metals
Use this form to direct Polycomp Administrative Services to make a precious metals investment from an existing account.
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Expense Payment Authorization Form
This form is required to authorize Polycomp Administrative Services to pay an expense for an asset held in an existing account (capital calls, property taxes, insurance premiums, utility payments, management fees, etc.).

This form may also be used as a blanket authorization, to pay all bills to a specified payee, for a specific asset.

Please note: This form is not used to direct Polycomp Administrative Services to purchase a new investment.
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Property Manager Waiver
For Real Estate investments, your custodian, Provident Trust Group, requires the submission of either a Property Manager agreement or a Property Manager Waiver. The Property Manager Waiver can be completed and returned to us with a Direction of Investment form.
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Loan Services Agreement
For Promissory Note investments, your custodian, Provident Trust Group, requires the submission of either a Loan Servicer agreement or a Loan Servicer Waiver. The Loan Servicer Waiver can be completed and returned to us with a Direction of Investment form.
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Distribution/Withdrawal Requests

Distribution Request - Recurring
This form is used to request a periodic recurring distribution from an existing Traditional IRA or Roth IRA at Polycomp Administrative Services.

Please note: You may choose to have recurring payments processed monthly, quarterly, semi-annually, or annual and by check or ACH. If ACH is chosen, please attach a copy of a voided check.
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Distribution Request - Traditional, SEP, SIMPLE
Use this form when taking a one-time distribution from a Traditional IRA, SEP IRA, or SIMPLE IRA at Polycomp Administrative Services.
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Distribution Request - Roth
Use this form when taking a one-time distribution from a Roth IRA at Polycomp Administrative Services.
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Distribution Request - Charitable
Use this form when taking a one-time distribution from an account at Polycomp Administrative Services, for which the payee is a Charitable Organization.
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Excess Removal Worksheet
This form is used to remove excess contribution funds from your Traditional IRA or Roth IRA at Polycomp Administrative Services.
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Change/Update Account Information

Beneficiary Designation - Addendum
This form is used to add additional beneficiary information to an applicable Beneficiary Designation Form or Account Application.
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Beneficiary Designation - Inherited
This form is used to add additional beneficiaries to an existing Inherited IRA account.

Please Note: This form voids all previous beneficiary elections.
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Beneficiary Designation - IRA
This form is used to add additional beneficiaries to an existing IRA account.

Please Note: This form voids all previous beneficiary elections.
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Change/Update Personal Contact Information
Use this form if you need to update your physical or mailing address, phone number, or email address.
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Fair Market Valuation Form
This form is used to update your custodian, Provident Trust Group as to the proper Fair Market Value (FMV) of assets held within your self-directed account. A fair market valuation should be submitted on a yearly basis to ensure proper tax reporting, the distribution of an asset in-kind, or to convert or re-characterize an asset.
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Agent Authorization
Complete this form to grant or revoke informational account access to a third-party representative. This form DOES NOT give the named party the ability to direct any activity within your account.
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Fee Schedule & Disclosure Forms

Fee Schedule
Please see this form for our standard fee schedule.
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Financial Disclosure
This disclosure provides the financial terms and conditions associated with an account with your custodian, Provident Trust Group.
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Privacy Policy Disclosure
This disclosure provides the terms and conditions on how we will and will not disclosure your personal information.
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NOTE: You will need Adobe Acrobat Reader in order to view the forms listed on this page. If you do not have Acrobat Reader, you can download it here for free.